Wie entstehen Guidelines? - Der Leitlinienprozess Matthias Müller, 29.03.2021 - Puls.at
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Wie entstehen Guidelines?
Der Leitlinienprozess
Matthias Müller, 29.03.2021
Reanimation ohne Guidelines...
2
Reanimation ohne Guidelines...
3
Reanimation ohne Guidelines...
4
Guidelines ohne Evidenz...
5
50er Jahre: Erste Evidenz
4 P.J.F. Baskett / Resuscitation 55 (2002) 3 !/7
[8]. I had the hon
at that time (Figs
Despite the en
time was found fo
admission Safar h
‘get it started and
that somehow wo
were difficult in th
enhance the meag
compressions. Gr
ingly towards inv
the dying process
primary cardiac
failure. At this sta
of Moscow and r
experimental wo
[12,13]. He was
scientists behind
Safar’s early
‘brains too good
sabbatical from
with Jim Snyder,
cerebral blood fl
cardiac arrest [1
cerebral hyperaem
sion. The efforts
J. Jude, W. Kouwenhoven, G. Knickerbocker P. Safar
In the field of resuscitation, with the help and
inspiration of Asmund Laerdal and Bjorn Lind [3],
Safar, Winchell and Berkebile in 1964 [4] studied the 6
acquisition of basic life support skills on a manikin
Das ABC der Reanimation
7
Safar P, Brown TC et al. JAMA 1961
1966: Die ersten Reanimationsguidelines
Heart-Lung Resuscitation National Academy of Sciences—National Research Council
Cardiopulmonary Resuscitation
Statement by the Ad Hoc Committee on Cardiopulmonary Resuscitation of the
Division of Medical Sciences, National Academy of Sciences\p=m-\NationalResearch Council
In May 1966, the work of an ad hoc Committee on In an editorial in Circulation in September 1962,'
Cardiopulmonary Resuscitation culminated in a Confer- closed-chest cardiopulmonary resuscitation was en¬
ence on Cardiopulmonary Resuscitation at the National dorsed as a medical procedure. Subsequently, the
Academy of Sciences-National Research Council (NAS\x=req-\ method was reclassified as an emergency procedure
NRC). This study was undertaken in response to inquiries in a second editorial in Circulation in May 1965.2
from the American National Red Cross and other national This was endorsed by the American Heart Associa¬
and federal agencies concerned with the need for stan- tion, the American National Red Cross, the In¬
dardized techniques of performance, training, and re- dustrial Medical Association, and the US Public
training requirements, and designation of the categories Health Service, which strongly recommended that
of persons to be taught mouth-to-mouth ventilation and the technique should be applied by "properly
7 Seiten, 2 Referenzen, 1 Grafik
external cardiac compression under present limitations
on the supply of instructors. The ad hoc committee care-
trained individuals of medical, dental, nursing and
allied health professions and of rescue squads."
fully reviewed and discussed these matters with repre- Since publication of the second editorial, the
sentatives of over 30 national organizations attending the American Heart Association, the Public Health
conference. The full proceedings of the conference will be Service, and other organizations have inaugurated
8
Downloaded From: http://jama.jamanetwork.com/ by a Simon Fraser University User on 06/02/2015
published by the NAS-NRC. A summary of the recom- intensive training programs in cardiopulmonary re¬
mendations of the ad hoc committee follows. suscitation in response to the widespread interest
and enthusiasm of motivated at all
Wozu eigentlich
Guidelines?
9
Pubmed-Suche: „Cardiac arrest“
10Die Lösung: Fachgesellschaften
Resuscitation, 24 (1992) 111-121 111
Elsevier Scientific Publishers Ireland Ltd.
Guidelines for advanced life support
A Statement by the Advanced Life Support Working Party
of the European Resuscitation Council, 1992
Douglas Chamberlain (England) Chairman, Leo Bossaert (Belgium), Pierre Carli (France), Erik Edgren
(Sweden), Lars Ekstrom (Sweden), Svein Hapnes (Norway), Stig Holmberg (Sweden), Rudy Koster
(Netherlands), Karl Lindner (Germany), Vittorio Pasqualucci (Italy), Narciso Perales (Spain), Martin
von Planta (Switzerland), Cohn Robertson (Scotland), Petter Steen (Norway)
111992: International Liaison Committee on
Resuscitation
12ILCOR Task Forces
Welche Fragen sind aktuell relevant?
In welchen Bereichen gibt es neue Literatur?
Wie ist diese Literatur zu bewerten?
13Von den Studien zur bestmöglichen Evidenz...
Führt bei PatientInnen
P Population
mit präklinischem
I Intervention Kreislaufstillstand (P)
Adrenalin (I) statt
C Comparator Kochsalzlösung (C)
O Outcome häufiger zu ROSC (O)?
14Von der PICO-Frage zur CoSTR
PICO-Frage
Regelmäßige Literatursuche
Updates
Begutachtung Bewertung der
Literatur
Consensus on
Science with
Treatment
Recommendations 15CoSTR 2020
184 strukturierte Reviews zu Fragestellungen
der Reanimation
16ERC Writing groups
17ERC Writing groups
Scope documents
Übernahme der ILCOR
Empfehlungen in die
Guidelines
Zusätzliche
Literaturrecherche +
Bewertung
Erster Entwurf (‚Draft‘)
Öffentliche Diskussion
Publikation der
Guidelines
18Gewissheit und Empfehlungsgrad
GRADE der Gewissheit
High
Moderate
Low
Very low
Empfehlungsgrad
Stark: „we recommend“
Schwach: „we suggest“
19Vom Draft zu den fertigen Guidelines
20...ein Beispiel
21Consensus on Science with Treatment
Recommendations (CoSTR)
22Consensus on Science with Treatment
Recommendations (CoSTR)
23Guideline writing groups – Scope documents
24Nix is‘ fix – der Guidelineprozess ist öffentlich!
25Nix is‘ fix – der Guidelineprozess ist öffentlich!
Guidelines 2020
Guideline title Chapter 6: Special circumstances
Guideline objective To provide evidence informed guidance for healthcare
professionals on modifications to advanced life support in
special circumstances
Intended audience All those involved in resuscitation in special circumstances
Setting Defined in relevant sections
Writing group Carsten Lott (chair), Anatolij Truhlář, Annette Alfonzo,
members Alessandro Barelli, Violeta Gonzalez-Salvado, Jochen Hinkelbein,
Jerry Nolan, Peter Paal, Gavin D Perkins, Jas Soar, Karl Thies,
Joyce Yeung, David Zideman
Section headings Key content / considerations
Hypoxia Pathophysiology and causes of asphyxial cardiac arrest, treatment and
outcome
Hypovolaemia To cover all aspects of TCA (blood loss, tension pneumothorax,
Traumatic cardiac arrest asphyxia, tamponade), priorisation of interventions, role of chest
(TCA) compressions,role of sonography, when to start and stop CPR, peri
arrest situation 26
Hypovolaemia Cross reference first aid3112 regions) will not provide any possibility to return rapidly to the next harbour, so autonomous
Vom Scope zum Draft – oder auch nicht
3113
3114
management of a cardiac arrest patient might be necessary.402
3115 This section is based on an evidence update on Cardiac arrest on a cruise ship produced by
3116 recent (randomized) clinical trials or systematic reviews and focused on scoping reviews
3117 addressing the questions:
3118 • General recommendations for Cardiac arrest on a cruise ship (16 titles screened/8
3119 abstracts screened/6 publications selected).
3120 • Recommendations for Post-resuscitation care for Cardiac arrest Cardiac arrest on a
3121 cruise ship (5 titles screened/5 abstracts screened/2 publications selected).
3122
3123 [h5] Cardiac Arrest on a cruise ship
3124
3125 If a cardiac arrest is recognised on a cruise ship, all medical resources should be used
3126 immediately. A medical first-responder team should be available 24/7, all equipment
3127 necessary for ALS should be available onboard and readily accessible. An AED should be
3128 onboard and requested immediately, since time to defibrillation is one of the most important
3129 factors for survival after cardiac arrest.403 Where there are insufficient numbers of crew
3130 health care professionals, an onboard announcement should be made to call for further
3131 medical professional help.404 Depending on the resources available telemedicine should be
3132 used as early as possible.405 Qualified medical air transportation is an option to cover long
3133 distances to medical facilities.
3134
3135 [h3] Cardiac arrest in sport
3136
3137 The incidence of sudden cardiac death (SCD) associated with sport or exercise in the
3138 general population is 0.46 per 100,000 person-years.406 There is a wide range in the
3139 incidence of SCD in those below 35 years of age (1.0 to 6.4 cases per 100,000 participant-
3140 years)407 depending on the study parameters and the incidence is markedly higher in those
3141 susceptible to cardiac arrythmias during or shortly after participating in sport.408 In a recent
3142 27
study involving 18.5 million person-years the incidence of SCA of sport related cardiac arrest
3143 was 0.76 cases per 100,000 athlete years.409 The same authors reported the highestVom CoSTR via Scopes zum Guideline Draft
„Was wird aus dem i.o.-Zugang?“
28...aber wie ist das
jetzt im Weltraum?
29ok o s i ti t e d a a l R u t t le e f ix
n t p t e s e d i c S h e c u r e q u
r e n
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n g S Problem
p
u i c k agibt:
n
c o n -
i n s t
h u q e
1992 [27]. T uced d a fairly . w e r
e d
Hinkelbein et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
e
(2020) 28:108
d ] e n t s u l a t p la
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https://doi.org/10.1186/s13049-020-00793-y
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Abstract
vi ty nt ted.
Background: With the “Artemis”-mission mankind will return to the Moon by 2024. Prolonged periods in space will
ition t coFragen?
matthias.mueller@meduniwien.ac.at
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